Development of a standardized language for case management among high-risk elderly.

Consistency and communication remain key barriers to tracking case management outcomes and developing the best practices. A dictionary of case management problems, goals, interventions, and outcomes was developed to support a prevention-oriented case management program targeted on elderly high-risk patients. Case management featured an annual screening questionnaire, appointment monitoring, disease education, self-management support, and ongoing care coordination. The dictionary resulted in a Standardized Language for Case Management (SLED). This has since been reviewed and modified on the basis of comments and recommendations from 5 leading case management organizations and is aligned with Standards of Practice for Case Management. The article provides a description of the standardized language terms, the rationale underlying the documentation, examples of how this dictionary of definitions can be incorporated into the daily practice of case management, and examples of some of the benefits to the field that can be achieved with the use of a common data-recording system.

Outcomes of preventive case management among high-risk elderly in three medical groups: a randomized clinical trial.

Preventive case management was implemented by Sharp Healthcare of San Diego with the intention of complementing primary care for geriatric patients enrolled in PacifiCare's Secure Horizons Medicare plan. This article presents patient outcomes after 12 months of participation. The program featured an annual screening questionnaire, appointment monitoring, disease education, and self-management support. It used a prospective design, tracking randomly assigned treatment (n= 1,537) and control patient samples (n = 1,542) for 12 months. Outcomes included physical and mental health status; hospital, ER, and nursing home use; hospital days and expenditures among persons having an inpatient stay; and primary care physician visits. Utilization data were obtained from Sharp Healthcare systems and from screening questionnaires. No statistically significant main effects were found, but persons with three or more independent activity of daily living limitations were about half as likely to have a nursing home admission if they were in case management rather than in the control group.